Neonatal Candidemia Caused by Candida haemulonii: Case Report and Review of Literature

Abstract

Candidemia is a frequent condition in Neonatal Intensive Care Units (NICU) and usually complicates the newborns clinical course. Several factors are responsible for candidiasis, such as prematurity and use of broad-spectrum antibiotics, and in these cases, there are the involvement of various Candida species, as C. albicans, and C. parapsilosis. However, other species as C. haemulonii has been rarely described in candidemia cases, being considered an emergent pathogen. Thus, we report a case of neonatal candidemia by C. haemulonii and a review of literature of fungemia by this yeast. The patient was a neonate with gestational age of 26 weeks and birth weight of 660 g hospitalized in a NICU from a Brazilian hospital. The identification of the etiological agent was performed by phenotypic methods, scanning electron microscopy, sequencing of the ITS region of rDNA, and mass spectrometry. Antifungal susceptibility testing was carried out according to the Clinical Laboratories and Standards Institute guidelines. The newborn was diagnosed with candidemia by C. haemulonii resistant to amphotericin B with minimal inhibitory concentration (MIC) of 8 µg/mL, sensitive to fluconazole (MIC: 8 µg/mL) and voriconazole (MIC: 0.12 µg/mL). The treatment with fluconazole (12 mg/kg/day) was established with good outcome. Candidemia by C. haemulonii is still being limited to a few sporadic cases in adults with endemic and restricted occurrences in neonates. Usually, the therapy with amphotericin B is ineffective against this species. Our results showed the importance of the mycological diagnosis associated to antifungigrama for the successful clinical management followed by important epidemiological data.

Identification and Antifungal Susceptibility Profiles of Candida haemulonii Species Complex Clinical Isolates from a Multicenter Study in China

“…In 2012, Cendejas-Bueno et al (8) proposed a reclassification of the C. haemulonii complex based on molecular methods; this taxonomic reclassification has prompted many laboratories to reexamine their culture collections for these species. To date, most of the C. haemulonii complex isolates identified by ITS sequencing were reported in Brazil (5,8,9,22), including 12 isolates and 31 isolates from two reports of a local national epidemiology study (9,22). We therefore determined the proportion of C. haemulonii complex isolates among clinical strains cultured from patients with IFDs in China and their antifungal susceptibilities by the broth microdilution method.…”

Biofilm Formed by Candida haemulonii Species Complex: Structural Analysis and Extracellular Matrix Composition

“…vulnera form a fungal complex (named C. haemulonii complex) that is represented by emergent, opportunistic yeasts able to cause human infections with a wide range of clinical manifestations, varying from superficial to deep-seated infections, especially in individuals with immunocompromising health conditions [1]. In this sense, the main isolation sites of the C. haemulonii species complex described in the literature are blood, foot ulcers, nails, bones, skin wounds, and vagina; however, there are reports of isolates obtained from other body fluids such as cerebrospinal fluid, bronchoalveolar lavage, vaginal discharge, pleural effusion, peritoneal and ascitic fluids, bile, and urine [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Successful fluconazole treatment of catheter-related candidemia caused by Candida haemulonii: report of 2 neonatal cases

“…In the past years, Candida species have been found to be important emerging nosocomial pathogens. Candida haemulonii, a kind of Candida species, has been reported to cause fungaemia, [3][4][5][6][7][8][9][10][11] osteitis, 12 peritonitis 13 and chronic otitis media.8 Up to now, the C. haemulonii candidemia has been described in five neonates, two (40.0%) of whom passed away. The relevant features of the 5 reported cases with candidemia caused by C. haemulonii are summarized in the Table 1.…”

“…According to the past reports, the possible risk factors of C. haemulonii candidemia are the widespread use of broad-spectrum antimicrobial agents,6 the use of invasive therapeutic devices (eg. catheters and mechanical ventilation), [6][7][8][9][10] premature patients, 3,4 oncology patients, 4,7,9,11 new surgical techniques 5 and chronic kidney disease. 9 In this report, Case 1, a premature who underwent an operation of NEC and who was on broad-spectrum antimicrobial agents.…”